A study presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting assessed the comparative efficacy and cost-effectiveness of daratumumab plus pomalidomide and dexamethasone (D-Pd) versus isatuximab plus pomalidomide and dexamethasone (I-Pd) for relapsed/refractory multiple myeloma (MM).
Study results were presented by Neda Alrawashdh, PharmD, Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson.
“Phase 2/3 clinical trials showed that isatuximab or daratumumab in combination with pomalidomide and low-dose dexamethasone significantly improve progression-free survival (PFS) in patients with relapsed/refractory MM,” said Dr Alrawashdh.
“However, no studies have assessed the comparative efficacy and cost-effectiveness of both regimens in management of relapsed/refractory MM,” she continued.
This study indirectly compared both D-Pd and I-Pd in terms of PFS and overall survival (OS) as well as evaluated the cost-effectiveness and cost-utility of the 2 regimens from a US payer’s perspective.
A partitioned survival model was developed for 3 health states: pre-progression, progression, and death. The model was run using 3 different time horizons: 1 year, 3 years, and 5 years.
An annual discount rate of 3.5% was applied for costs and outcomes beyond the first year. The life years (LY) and quality adjusted LY (QALY) for each treatment, as well as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were estimated in both base and probabilistic sensitivity analyses.
Median PFS was estimated to be 9.5 months for D-Pd and 14.5 months for I-Pd. Median OS estimates were 18 months and 26 months, respectively.
I-Pd is associated with greater LY and QALY gains a 1 year, 3 years, and 5 years. Additionally, costs at 1 year, 3 years, and 5 years are less than that of D-Pd. At 5 years, I-Pd was associated with incremental benefits (0.57 LY, 0.35 QALY) and incremental costs of $88,271 versus D-Pd. At a willingness-to-par threshold of $100,000, the probability that I-Pd is cost-effective was 100% at 1 year, 65% at 3 years, and 23% at 5 years.
Clinically, [I-Pd] is associated with incremental survival gains of ~1 month and quality-adjusted survival gains of 0.5 month than [D-Pd] when patients are treated for 1 year. The benefits increase with treatment duration to reach ~7 months life year gains and 4 months quality-adjusted life year gains if patients treated for 5 years,” concluded Dr Alrawashdh.
“Due to its lower total costs, [I-Pd] yielded saving ICERs at 1 and 3 years. However, [I-Pd] cost exceeded [D-Pd] at 5 years’ time horizon to yield an ICER above the willingness-to-pay threshold,” she added.—Janelle Bradley
Alrawashdh N, Almutairi A, McBride A, Abraham I. Economic Evaluation of Daratumumab and Pomalidomide and Dexamethasone Versus Isatuximab and Pomalidomide and Dexamethasone for Patients with Relapsed or Refractory Multiple Myeloma. Presented at: the 62nd ASH Annual Meeting and Exposition; Dec 5-8, 2020. Abstract 3419.
